Dr. Steven Wolf writes, a rehabilitation stroke expert and professor at Emory University School of Medicine in Atlanta. "Stroke patients need to rely more on their own problem solving to regain mobility".
http://www.fiercehealthcare.com/story/new-sites-allow-patients-compare-surgeons-based-outcomes-complication-rates/2015-07-14
Two new sites launched today will allow consumers to evaluate and compare surgeons based on never-before-available information on complications rates and patient outcomes.
The first, www.surgeonratings.org,
released by the
nonprofit Consumers' Checkbook/Center for the Study of Services, only
lists surgeons that have had better-than-average outcomes based on an
analysis of more than four million surgeries conducted by 50,000
surgeons on hospital inpatients.
The ratings, which don't include poor performers, take into account how often the surgeon's patients die in the hospital or within 90 days of discharge, have serious complications in the hospital
or are readmitted to the hospital within 90 days of discharge.
The site allows consumers to
search by ZIP code for the top-peforming surgeons in 14 high-risk
surgeries, including heart valve and bypass surgery and total knee and
hip replacement.
Ratings are based on federal government records previously not
available to the public, the organization announced.
"This is the first time we're
doing this and it's going to catch people by surprise," said Robert
Krughoff, Checkbook's president, in the announcement.
"So we chose this time to focus on the good ones and to tell people
who they are."
But the second website, Surgeon
Scorecard by ProPublica, does include surgeons that have
higher-than-average complications based on infections, clots or
infections that call for post-operative care.
The non-profit news outlet
calculated death and complication rates for surgeons who perform one of
eight elective procedures in Medicare, including gall bladder removal
and hip replacements, adjusting for differences in patient health, age
and hospital quality.
In an editor's note,
Stephen Engelberg said that the publication decided a year ago to
publicly compare the performance of surgeons because consumers didn't
have access to the information.
"These days, consumers can
review ratings on everything from plumbers to hair salons to the latest
digital cameras," he said.
"The process of undergoing surgery includes some of the most
consequential decisions any of us ever make.
So we began with the view that the taxpayers who pay the costs of
Medicare should be able to use its data to make the best possible
decisions about their healthcare."
The news outlet consulted
with patient safety leaders and hired a
biostatics professor from the Harvard School of Public Health to develop
a methodology it aims to be useful to patients and fair to surgeons.
It focused on non-emergency operations scheduled in advance and
generally performed on patients who are in stable health.
To be fair to surgeons,
Engelberg said the publication excluded patients who came in through the
emergency room or were transferred to the hospital from another
facility.
Comparisons of performance are based on deaths while in the hospital
and readmissions that were the likely result of a post-operative
complication within 30 days.
Ultimately, Engelberg said, the publication hopes the information will lead to a reduction in preventable medical errors, by spurring accountability for breakdowns in
patient care.
The tool is already generating feedback in the patient safety community.
"I would be surprised if any
experienced clinician challenged the basic finding, which is that there
is real variation among surgeons," wrote
Thomas Lee, M.D.
"A critical step toward improving care is to recognize that there
are opportunities to improve.
I think transparency on quality is a powerful tool, and, frankly, I
prefer that to financial incentives as a way to drive competition and
improvement on quality."
But Peter Pronovost, M.D.,
senior vice president for patient safety and quality, director of the
Armstrong Institute for Patient Safety and Quality at Johns Hopkins
Medicine in Baltimore, said the ProPublica
measure isn't valid.
He claims that the method should include all patients who face the
same probability of being readmitted.
In addition, he said that the model should be tested and validated
before presenting it as a tool that consumers can use for medical
decision-making.
And in her blog, Jennifer Gunter, M.D., wrote
that the tool may actually backfire because it doesn't take into account
that many surgeons operate on high-risk patients who still need
surgery.
She worries that the model may lead to surgeons choosing to operate
on lower-risk patients so they can improve their scores.
"What if every surgeon only operated on the good candidates?" she
wrote.
"People at higher risk for complications will suffer and we will
never get surgeons with superior skills."
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